@article{FroehlichZahnerSchmalzingetal.2023, author = {Froehlich, Matthias and Zahner, Antonia and Schmalzing, Marc and Gernert, Michael and Strunz, Patrick-Pascal and Hueper, Sebastian and Portegys, Jan and Schwaneck, Eva Christina and Gadeholt, Ottar and K{\"u}bler, Andrea and Hewig, Johannes and Ziebell, Philipp}, title = {Patient-reported outcomes provide evidence for increased depressive symptoms and increased mental impairment in giant cell arteritis}, series = {Frontiers in Medicine}, volume = {10}, journal = {Frontiers in Medicine}, doi = {10.3389/fmed.2023.1146815}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-319761}, year = {2023}, abstract = {Objectives The spectrum of giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) represents highly inflammatory rheumatic diseases. Patients mostly report severe physical impairment. Possible consequences for mental health have been scarcely studied. The aim of this study was to investigate psychological well-being in the context of GCA and PMR. Methods Cross-sectional study with N = 100 patients with GCA and/or PMR (GCA-PMR). Patient-reported outcomes (PROs) were measured using the Short Form 36 Version 2 (SF-36v2) and visual analog scale (VAS) assessment. Moreover, the Patient Health Questionnaire 9 (PHQ-9) was used in 35 of 100 patients to detect depression. To compare PROs with physician assessment, VAS was also rated from physician perspective. To assess a possible association with inflammation itself, serological parameters of inflammation (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR]) were included. Results In all scales of the SF-36v2 except General Health (GH) and in the physical and mental sum score (PCS, MCS), a significant impairment compared to the German reference collective was evident (MCS: d = 0.533, p < 0.001). In the PHQ-9 categorization, 14 of the 35 (40\%) showed evidence of major depression disorder. VAS Patient correlated significantly with PHQ-9 and SF-36 in all categories, while VAS Physician showed only correlations to physical categories and not in the mental dimensions. Regarding inflammatory parameters, linear regression showed CRP to be a complementary significant positive predictor of mental health subscale score, independent of pain. Conclusion PRO show a relevant impairment of mental health up to symptoms of major depression disorder. The degree of depressive symptoms is also distinctly associated with the serological inflammatory marker CRP.}, language = {en} } @article{GrappEllKiermeieretal.2022, author = {Grapp, Miriam and Ell, Johanna and Kiermeier, Senta and Haun, Markus W. and K{\"u}bler, Andrea and Friederich, Hans-Christoph and Maatouk, Imad}, title = {Feasibility study of a self-guided internet-based intervention for family caregivers of patients with cancer (OAse)}, series = {Scientific Reports}, volume = {12}, journal = {Scientific Reports}, doi = {10.1038/s41598-022-21157-9}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-300537}, year = {2022}, abstract = {Despite high levels of distress, family caregivers of patients with cancer rarely seek psychosocial support and Internet-based interventions (IBIs) are a promising approach to reduce some access barriers. Therefore, we developed a self-guided IBI for family caregivers of patients with cancer (OAse), which, in addition to patients' spouses, also addresses other family members (e.g., adult children, parents). This study aimed to determine the feasibility of OAse (recruitment, dropout, adherence, participant satisfaction). Secondary outcomes were caregivers' self-efficacy, emotional state, and supportive care needs. N = 41 family caregivers participated in the study (female: 65\%), mostly spouses (71\%), followed by children (20\%), parents (7\%), and friends (2\%). Recruitment (47\%), retention (68\%), and adherence rates (76\% completed at least 4 of 6 lessons) support the feasibility of OAse. Overall, the results showed a high degree of overall participant satisfaction (96\%). There were no significant pre-post differences in secondary outcome criteria, but a trend toward improvement in managing difficult interactions/emotions (p = .06) and depression/anxiety (p = .06). Although the efficacy of the intervention remains to be investigated, our results suggest that OAse can be well implemented in caregivers' daily lives and has the potential to improve family caregivers' coping strategies.}, language = {en} } @article{KleihDahmsBotrelKuebler2021, author = {Kleih-Dahms, Sonja Christina and Botrel, Loic and K{\"u}bler, Andrea}, title = {The influence of motivation and emotion on sensorimotor rhythm-based brain-computer interface performance}, series = {Psychophysiology}, volume = {58}, journal = {Psychophysiology}, number = {8}, doi = {10.1111/psyp.13832}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-259664}, year = {2021}, abstract = {While decades of research have investigated and technically improved brain-computer interface (BCI)-controlled applications, relatively little is known about the psychological aspects of brain-computer interfacing. In 35 healthy students, we investigated whether extrinsic motivation manipulated via monetary reward and emotional state manipulated via video and music would influence behavioral and psychophysiological measures of performance with a sensorimotor rhythm (SMR)-based BCI. We found increased task-related brain activity in extrinsically motivated (rewarded) as compared with nonmotivated participants but no clear effect of emotional state manipulation. Our experiment investigated the short-term effect of motivation and emotion manipulation in a group of young healthy subjects, and thus, the significance for patients in the locked-in state, who may be in need of a BCI, remains to be investigated.}, language = {en} } @article{EidelKuebler2020, author = {Eidel, Matthias and K{\"u}bler, Andrea}, title = {Wheelchair Control in a Virtual Environment by Healthy Participants Using a P300-BCI Based on Tactile Stimulation: Training Effects and Usability}, series = {Frontiers in Human Neuroscience}, volume = {14}, journal = {Frontiers in Human Neuroscience}, issn = {1662-5161}, doi = {10.3389/fnhum.2020.00265}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-207775}, year = {2020}, abstract = {Tactile stimulation is less frequently used than visual for brain-computer interface (BCI) control, partly because of limitations in speed and accuracy. Non-visual BCI paradigms, however, may be required for patients who struggle with vision dependent BCIs because of a loss of gaze control. With the present study, we attempted to replicate earlier results by Herweg et al. (2016), with several minor adjustments and a focus on training effects and usability. We invited 16 healthy participants and trained them with a 4-class tactile P300-based BCI in five sessions. Their main task was to navigate a virtual wheelchair through a 3D apartment using the BCI. We found significant training effects on information transfer rate (ITR), which increased from a mean of 3.10-9.50 bits/min. Further, both online and offline accuracies significantly increased with training from 65\% to 86\% and 70\% to 95\%, respectively. We found only a descriptive increase of P300 amplitudes at Fz and Cz with training. Furthermore, we report subjective data from questionnaires, which indicated a relatively high workload and moderate to high satisfaction. Although our participants have not achieved the same high performance as in the Herweg et al. (2016) study, we provide evidence for training effects on performance with a tactile BCI and confirm the feasibility of the paradigm.}, language = {en} } @article{LuleKueblerLudolph2019, author = {Lul{\´e}, Doroth{\´e}e and K{\"u}bler, Andrea and Ludolph, Albert C.}, title = {Ethical principles in patient-centered medical care to support quality of life in amyotrophic lateral sclerosis}, series = {Frontiers in Neurology}, volume = {10}, journal = {Frontiers in Neurology}, issn = {1664-2295}, doi = {10.3389/fneur.2019.00259}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-196239}, year = {2019}, abstract = {It is one of the primary goals of medical care to secure good quality of life (QoL) while prolonging survival. This is a major challenge in severe medical conditions with a prognosis such as amyotrophic lateral sclerosis (ALS). Further, the definition of QoL and the question whether survival in this severe condition is compatible with a good QoL is a matter of subjective and culture-specific debate. Some people without neurodegenerative conditions believe that physical decline is incompatible with satisfactory QoL. Current data provide extensive evidence that psychosocial adaptation in ALS is possible, indicated by a satisfactory QoL. Thus, there is no fatalistic link of loss of QoL when physical health declines. There are intrinsic and extrinsic factors that have been shown to successfully facilitate and secure QoL in ALS which will be reviewed in the following article following the four ethical principles (1) Beneficence, (2) Non-maleficence, (3) Autonomy and (4) Justice, which are regarded as key elements of patient centered medical care according to Beauchamp and Childress. This is a JPND-funded work to summarize findings of the project NEEDSinALS (www.NEEDSinALS.com) which highlights subjective perspectives and preferences in medical decision making in ALS.}, language = {en} } @article{PaeleckeHabermannPaeleckeMauthetal.2019, author = {Paelecke-Habermann, Yvonne and Paelecke, Marko and Mauth, Juliane and Tschisgale, Juliane and Lindenmeyer, Johannes and K{\"u}bler, Andrea}, title = {A comparison of implicit and explicit reward learning in low risk alcohol users versus people who binge drink and people with alcohol dependence}, series = {Addictive Behaviors Reports}, volume = {9}, journal = {Addictive Behaviors Reports}, doi = {10.1016/j.abrep.2019.100178}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-201406}, pages = {100178}, year = {2019}, abstract = {Chronic alcohol use leads to specific neurobiological alterations in the dopaminergic brain reward system, which probably are leading to a reward deficiency syndrome in alcohol dependence. The purpose of our study was to examine the effects of such hypothesized neurobiological alterations on the behavioral level, and more precisely on the implicit and explicit reward learning. Alcohol users were classified as dependent drinkers (using the DSM-IV criteria), binge drinkers (using criteria of the USA National Institute on Alcohol Abuse and Alcoholism) or low-risk drinkers (following recommendations of the Scientific board of trustees of the German Health Ministry). The final sample (n = 94) consisted of 36 low-risk alcohol users, 37 binge drinkers and 21 abstinent alcohol dependent patients. Participants were administered a probabilistic implicit reward learning task and an explicit reward- and punishment-based trial-and-error-learning task. Alcohol dependent patients showed a lower performance in implicit and explicit reward learning than low risk drinkers. Binge drinkers learned less than low-risk drinkers in the implicit learning task. The results support the assumption that binge drinking and alcohol dependence are related to a chronic reward deficit. Binge drinking accompanied by implicit reward learning deficits could increase the risk for the development of an alcohol dependence.}, language = {en} } @article{LugoQuitadamoBianchietal.2016, author = {Lugo, Zulay R. and Quitadamo, Lucia R. and Bianchi, Luigi and Pellas, Fr{\´e}deric and Veser, Sandra and Lesenfants, Damien and Real, Ruben G. L. and Herbert, Cornelia and Guger, Christoph and Kotchoubey, Boris and Mattia, Donatella and K{\"u}bler, Andrea and Laureys, Steven and Noirhomme, Quentin}, title = {Cognitive Processing in Non-Communicative Patients: What Can Event-Related Potentials Tell Us?}, series = {Frontiers in Human Neuroscience}, volume = {10}, journal = {Frontiers in Human Neuroscience}, number = {569}, doi = {10.3389/fnhum.2016.00569}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-165165}, year = {2016}, abstract = {Event-related potentials (ERP) have been proposed to improve the differential diagnosis of non-responsive patients. We investigated the potential of the P300 as a reliable marker of conscious processing in patients with locked-in syndrome (LIS). Eleven chronic LIS patients and 10 healthy subjects (HS) listened to a complex-tone auditory oddball paradigm, first in a passive condition (listen to the sounds) and then in an active condition (counting the deviant tones). Seven out of nine HS displayed a P300 waveform in the passive condition and all in the active condition. HS showed statistically significant changes in peak and area amplitude between conditions. Three out of seven LIS patients showed the P3 waveform in the passive condition and five of seven in the active condition. No changes in peak amplitude and only a significant difference at one electrode in area amplitude were observed in this group between conditions. We conclude that, in spite of keeping full consciousness and intact or nearly intact cortical functions, compared to HS, LIS patients present less reliable results when testing with ERP, specifically in the passive condition. We thus strongly recommend applying ERP paradigms in an active condition when evaluating consciousness in non-responsive patients.}, language = {en} } @article{ZhouAllisonKuebleretal.2016, author = {Zhou, Sijie and Allison, Brendan Z. and K{\"u}bler, Andrea and Cichocki, Andrzej and Wang, Xingyu and Jin, Jing}, title = {Effects of Background Music on Objective and Subjective Performance Measures in an Auditory BCI}, series = {Frontiers in Computational Neuroscience}, volume = {10}, journal = {Frontiers in Computational Neuroscience}, number = {105}, doi = {10.3389/fncom.2016.00105}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-165101}, year = {2016}, abstract = {Several studies have explored brain computer interface (BCI) systems based on auditory stimuli, which could help patients with visual impairments. Usability and user satisfaction are important considerations in any BCI. Although background music can influence emotion and performance in other task environments, and many users may wish to listen to music while using a BCI, auditory, and other BCIs are typically studied without background music. Some work has explored the possibility of using polyphonic music in auditory BCI systems. However, this approach requires users with good musical skills, and has not been explored in online experiments. Our hypothesis was that an auditory BCI with background music would be preferred by subjects over a similar BCI without background music, without any difference in BCI performance. We introduce a simple paradigm (which does not require musical skill) using percussion instrument sound stimuli and background music, and evaluated it in both offline and online experiments. The result showed that subjects preferred the auditory BCI with background music. Different performance measures did not reveal any significant performance effect when comparing background music vs. no background. Since the addition of background music does not impair BCI performance but is preferred by users, auditory (and perhaps other) BCIs should consider including it. Our study also indicates that auditory BCIs can be effective even if the auditory channel is simultaneously otherwise engaged.}, language = {en} } @article{MatuzBirbaumerHautzingeretal., author = {Matuz, Tamara and Birbaumer, Niels and Hautzinger, Martin and K{\"u}bler, Andrea}, title = {Psychosocial adjustment to ALS: a longitudinal study}, series = {Frontiers in Psychology}, volume = {6}, journal = {Frontiers in Psychology}, number = {1197}, issn = {1664-1078}, doi = {10.3389/fpsyg.2015.01197}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-190208}, abstract = {For the current study the Lazarian stress-coping theory and the appendant model of psychosocial adjustment to chronic illness and disabilities (Pakenham, 1999) has shaped the foundation for identifying determinants of adjustment to ALS. We aimed to investigate the evolution of psychosocial adjustment to ALS and to determine its long-term predictors. A longitudinal study design with four measurement time points was therefore, used to assess patients' quality of life, depression, and stress-coping model related aspects, such as illness characteristics, social support, cognitive appraisals, and coping strategies during a period of 2 years. Regression analyses revealed that 55\% of the variance of severity of depressive symptoms and 47\% of the variance in quality of life at T2 was accounted for by all the T1 predictor variables taken together. On the level of individual contributions, protective buffering, and appraisal of own coping potential accounted for a significant percentage in the variance in severity of depressive symptoms, whereas problem management coping strategies explained variance in quality of life scores. Illness characteristics at T2 did not explain any variance of both adjustment outcomes. Overall, the pattern of the longitudinal results indicated stable depressive symptoms and quality of life indices reflecting a successful adjustment to the disease across four measurement time points during a period of about two years. Empirical evidence is provided for the predictive value of social support, cognitive appraisals, and coping strategies, but not illness parameters such as severity and duration for adaptation to ALS. The current study contributes to a better conceptualization of adjustment, allowing us to provide evidence-based support beyond medical and physical intervention for people with ALS.}, language = {en} } @article{AcqualagnaBotrelVidaurreetal.2016, author = {Acqualagna, Laura and Botrel, Loic and Vidaurre, Carmen and K{\"u}bler, Andrea and Blankertz, Benjamin}, title = {Large-Scale Assessment of a Fully Automatic Co-Adaptive Motor Imagery-Based Brain Computer Interface}, series = {PLoS ONE}, volume = {11}, journal = {PLoS ONE}, number = {2}, doi = {10.1371/journal.pone.0148886}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-167230}, pages = {e0148886}, year = {2016}, abstract = {In the last years Brain Computer Interface (BCI) technology has benefited from the development of sophisticated machine leaning methods that let the user operate the BCI after a few trials of calibration. One remarkable example is the recent development of co-adaptive techniques that proved to extend the use of BCIs also to people not able to achieve successful control with the standard BCI procedure. Especially for BCIs based on the modulation of the Sensorimotor Rhythm (SMR) these improvements are essential, since a not negligible percentage of users is unable to operate SMR-BCIs efficiently. In this study we evaluated for the first time a fully automatic co-adaptive BCI system on a large scale. A pool of 168 participants naive to BCIs operated the co-adaptive SMR-BCI in one single session. Different psychological interventions were performed prior the BCI session in order to investigate how motor coordination training and relaxation could influence BCI performance. A neurophysiological indicator based on the Power Spectral Density (PSD) was extracted by the recording of few minutes of resting state brain activity and tested as predictor of BCI performances. Results show that high accuracies in operating the BCI could be reached by the majority of the participants before the end of the session. BCI performances could be significantly predicted by the neurophysiological indicator, consolidating the validity of the model previously developed. Anyway, we still found about 22\% of users with performance significantly lower than the threshold of efficient BCI control at the end of the session. Being the inter-subject variability still the major problem of BCI technology, we pointed out crucial issues for those who did not achieve sufficient control. Finally, we propose valid developments to move a step forward to the applicability of the promising co-adaptive methods.}, language = {en} } @article{HerbertKuebler2011, author = {Herbert, Cornelia and K{\"u}bler, Andrea}, title = {Dogs Cannot Bark: Event-Related Brain Responses to True and False Negated Statements as Indicators of Higher-Order Conscious Processing}, series = {PLoS ONE}, volume = {6}, journal = {PLoS ONE}, number = {10}, doi = {10.1371/journal.pone.0025574}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-135165}, pages = {e25574}, year = {2011}, abstract = {The present study investigated event-related brain potentials elicited by true and false negated statements to evaluate if discrimination of the truth value of negated information relies on conscious processing and requires higher-order cognitive processing in healthy subjects across different levels of stimulus complexity. The stimulus material consisted of true and false negated sentences (sentence level) and prime-target expressions (word level). Stimuli were presented acoustically and no overt behavioral response of the participants was required. Event-related brain potentials to target words preceded by true and false negated expressions were analyzed both within group and at the single subject level. Across the different processing conditions (word pairs and sentences), target words elicited a frontal negativity and a late positivity in the time window from 600-1000 msec post target word onset. Amplitudes of both brain potentials varied as a function of the truth value of the negated expressions. Results were confirmed at the single-subject level. In sum, our results support recent suggestions according to which evaluation of the truth value of a negated expression is a time-and cognitively demanding process that cannot be solved automatically, and thus requires conscious processing. Our paradigm provides insight into higher-order processing related to language comprehension and reasoning in healthy subjects. Future studies are needed to evaluate if our paradigm also proves sensitive for the detection of consciousness in non-responsive patients.}, language = {en} } @article{MirallesVargiuDauwalderetal.2015, author = {Miralles, Felip and Vargiu, Eloisa and Dauwalder, Stefan and Sol{\`a}, Marc and M{\"u}ller-Putz, Gernot and Wriessnegger, Selina C. and Pinegger, Andreas and K{\"u}bler, Andrea and Halder, Sebastian and K{\"a}thner, Ivo and Martin, Suzanne and Daly, Jean and Armstrong, Elaine and Guger, Christoph and Hinterm{\"u}ller, Christoph and Lowish, Hannah}, title = {Brain computer interface on track to home.}, series = {The Scientific World Journal}, volume = {2015}, journal = {The Scientific World Journal}, number = {623896}, doi = {10.1155/2015/623896}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-149575}, year = {2015}, abstract = {The novel BackHome system offers individuals with disabilities a range of useful services available via brain-computer interfaces (BCIs), to help restore their independence. This is the time such technology is ready to be deployed in the real world, that is, at the target end users' home. This has been achieved by the development of practical electrodes, easy to use software, and delivering telemonitoring and home support capabilities which have been conceived, implemented, and tested within a user-centred design approach. The final BackHome system is the result of a 3-year long process involving extensive user engagement to maximize effectiveness, reliability, robustness, and ease of use of a home based BCI system. The system is comprised of ergonomic and hassle-free BCI equipment; one-click software services for Smart Home control, cognitive stimulation, and web browsing; and remote telemonitoring and home support tools to enable independent home use for nonexpert caregivers and users. BackHome aims to successfully bring BCIs to the home of people with limited mobility to restore their independence and ultimately improve their quality of life.}, language = {en} } @article{KaethnerKueblerHalder2015, author = {K{\"a}thner, Ivo and K{\"u}bler, Andrea and Halder, Sebastian}, title = {Rapid P300 brain-computer interface communication with a head-mounted display}, series = {Frontiers in Neuroscience}, volume = {9}, journal = {Frontiers in Neuroscience}, number = {207}, doi = {10.3389/fnins.2015.00207}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-148520}, year = {2015}, abstract = {Visual ERP (P300) based brain-computer interfaces (BCIs) allow for fast and reliable spelling and are intended as a muscle-independent communication channel for people with severe paralysis. However, they require the presentation of visual stimuli in the field of view of the user. A head-mounted display could allow convenient presentation of visual stimuli in situations, where mounting a conventional monitor might be difficult or not feasible (e.g., at a patient's bedside). To explore if similar accuracies can be achieved with a virtual reality (VR) headset compared to a conventional flat screen monitor, we conducted an experiment with 18 healthy participants. We also evaluated it with a person in the locked-in state (LIS) to verify that usage of the headset is possible for a severely paralyzed person. Healthy participants performed online spelling with three different display methods. In one condition a 5 x 5 letter matrix was presented on a conventional 22 inch TFT monitor. Two configurations of the VR headset were tested. In the first (glasses A), the same 5 x 5 matrix filled the field of view of the user. In the second (glasses B), single letters of the matrix filled the field of view of the user. The participant in the LIS tested the VR headset on three different occasions (glasses A condition only). For healthy participants, average online spelling accuracies were 94\% (15.5 bits/min) using three flash sequences for spelling with the monitor and glasses A and 96\% (16.2 bits/min) with glasses B. In one session, the participant in the LIS reached an online spelling accuracy of 100\% (10 bits/min) using the glasses A condition. We also demonstrated that spelling with one flash sequence is possible with the VR headset for healthy users (mean: 32.1 bits/min, maximum reached by one user: 71.89 bits/min at 100\% accuracy). We conclude that the VR headset allows for rapid P300 BCI communication in healthy users and may be a suitable display option for severely paralyzed persons.}, language = {en} } @article{KaethnerHalderHintermuelleretal.2017, author = {K{\"a}thner, Ivo and Halder, Sebastian and Hinterm{\"u}ller, Christoph and Espinosa, Arnau and Guger, Christoph and Miralles, Felip and Vargiu, Eloisa and Dauwalder, Stefan and Rafael-Palou, Xavier and Sol{\`a}, Marc and Daly, Jean M. and Armstrong, Elaine and Martin, Suzanne and K{\"u}bler, Andrea}, title = {A Multifunctional Brain-Computer Interface Intended for Home Use: An Evaluation with Healthy Participants and Potential End Users with Dry and Gel-Based Electrodes}, series = {Frontiers in Neuroscience}, volume = {11}, journal = {Frontiers in Neuroscience}, number = {286}, doi = {10.3389/fnins.2017.00286}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-157925}, year = {2017}, abstract = {Current brain-computer interface (BCIs) software is often tailored to the needs of scientists and technicians and therefore complex to allow for versatile use. To facilitate home use of BCIs a multifunctional P300 BCI with a graphical user interface intended for non-expert set-up and control was designed and implemented. The system includes applications for spelling, web access, entertainment, artistic expression and environmental control. In addition to new software, it also includes new hardware for the recording of electroencephalogram (EEG) signals. The EEG system consists of a small and wireless amplifier attached to a cap that can be equipped with gel-based or dry contact electrodes. The system was systematically evaluated with a healthy sample, and targeted end users of BCI technology, i.e., people with a varying degree of motor impairment tested the BCI in a series of individual case studies. Usability was assessed in terms of effectiveness, efficiency and satisfaction. Feedback of users was gathered with structured questionnaires. Two groups of healthy participants completed an experimental protocol with the gel-based and the dry contact electrodes (N = 10 each). The results demonstrated that all healthy participants gained control over the system and achieved satisfactory to high accuracies with both gel-based and dry electrodes (average error rates of 6 and 13\%). Average satisfaction ratings were high, but certain aspects of the system such as the wearing comfort of the dry electrodes and design of the cap, and speed (in both groups) were criticized by some participants. Six potential end users tested the system during supervised sessions. The achieved accuracies varied greatly from no control to high control with accuracies comparable to that of healthy volunteers. Satisfaction ratings of the two end-users that gained control of the system were lower as compared to healthy participants. The advantages and disadvantages of the BCI and its applications are discussed and suggestions are presented for improvements to pave the way for user friendly BCIs intended to be used as assistive technology by persons with severe paralysis.}, language = {en} } @article{ErlbeckMochtyKuebleretal.2017, author = {Erlbeck, Helena and Mochty, Ursula and K{\"u}bler, Andrea and Real, Ruben G. L.}, title = {Circadian course of the P300 ERP in patients with amyotrophic lateral sclerosis - implications for brain-computer interfaces (BCI)}, series = {BMC Neurology}, volume = {17}, journal = {BMC Neurology}, number = {3}, doi = {10.1186/s12883-016-0782-1}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-157423}, year = {2017}, abstract = {Background: Accidents or neurodegenerative diseases like amyotrophic lateral sclerosis (ALS) can lead to progressing, extensive, and complete paralysis leaving patients aware but unable to communicate (locked-in state). Brain-computer interfaces (BCI) based on electroencephalography represent an important approach to establish communication with these patients. The most common BCI for communication rely on the P300, a positive deflection arising in response to rare events. To foster broader application of BCIs for restoring lost function, also for end-users with impaired vision, we explored whether there were specific time windows during the day in which a P300 driven BCI should be preferably applied. Methods: The present study investigated the influence of time of the day and modality (visual vs. auditory) on P300 amplitude and latency. A sample of 14 patients (end-users) with ALS and 14 healthy age matched volunteers participated in the study and P300 event-related potentials (ERP) were recorded at four different times (10, 12 am, 2, \& 4 pm) during the day. Results: Results indicated no differences in P300 amplitudes or latencies between groups (ALS patients v. healthy participants) or time of measurement. In the auditory condition, latencies were shorter and amplitudes smaller as compared to the visual condition. Conclusion: Our findings suggest applicability of EEG/BCI sessions in patients with ALS throughout normal waking hours. Future studies using actual BCI systems are needed to generalize these findings with regard to BCI effectiveness/efficiency and other times of day.}, language = {en} } @article{SchererFallerFriedrichetal.2015, author = {Scherer, Reinhold and Faller, Josef and Friedrich, Elisabeth V. C. and Opisso, Eloy and Costa, Ursula and K{\"u}bler, Andrea and M{\"u}ller-Putz, Gernot R.}, title = {Individually Adapted Imagery Improves Brain-Computer Interface Performance in End-Users with Disability}, series = {PLoS ONE}, volume = {10}, journal = {PLoS ONE}, number = {5}, doi = {10.1371/journal.pone.0123727}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-143021}, pages = {e0123727}, year = {2015}, abstract = {Brain-computer interfaces (BCIs) translate oscillatory electroencephalogram (EEG) patterns into action. Different mental activities modulate spontaneous EEG rhythms in various ways. Non-stationarity and inherent variability of EEG signals, however, make reliable recognition of modulated EEG patterns challenging. Able-bodied individuals who use a BCI for the first time achieve - on average - binary classification performance of about 75\%. Performance in users with central nervous system (CNS) tissue damage is typically lower. User training generally enhances reliability of EEG pattern generation and thus also robustness of pattern recognition. In this study, we investigated the impact of mental tasks on binary classification performance in BCI users with central nervous system (CNS) tissue damage such as persons with stroke or spinal cord injury (SCI). Motor imagery (MI), that is the kinesthetic imagination of movement (e.g. squeezing a rubber ball with the right hand), is the "gold standard" and mainly used to modulate EEG patterns. Based on our recent results in able-bodied users, we hypothesized that pair- wise combination of "brain-teaser" (e.g. mental subtraction and mental word association) and "dynamic imagery" (e. g. hand and feet MI) tasks significantly increases classification performance of induced EEG patterns in the selected end-user group. Within- day (How stable is the classification within a day?) and between-day (How well does a model trained on day one perform on unseen data of day two?) analysis of variability of mental task pair classification in nine individuals confirmed the hypothesis. We found that the use of the classical MI task pair hand vs. feed leads to significantly lower classification accuracy - in average up to 15\% less - in most users with stroke or SCI. User-specific selection of task pairs was again essential to enhance performance. We expect that the gained evidence will significantly contribute to make imagery-based BCI technology become accessible to a larger population of users including individuals with special needs due to CNS damage.}, language = {en} } @article{JinAllisonKaufmannetal.2012, author = {Jin, Jing and Allison, Brendan Z. and Kaufmann, Tobias and K{\"u}bler, Andrea and Zhang, Yu and Wang, Xingyu and Cichocki, Andrzej}, title = {The Changing Face of P300 BCIs: A Comparison of Stimulus Changes in a P300 BCI Involving Faces, Emotion, and Movement}, series = {PLoS One}, volume = {7}, journal = {PLoS One}, number = {11}, doi = {10.1371/journal.pone.0049688}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-134173}, pages = {e49688}, year = {2012}, abstract = {Background: One of the most common types of brain-computer interfaces (BCIs) is called a P300 BCI, since it relies on the P300 and other event-related potentials (ERPs). In the canonical P300 BCI approach, items on a monitor flash briefly to elicit the necessary ERPs. Very recent work has shown that this approach may yield lower performance than alternate paradigms in which the items do not flash but instead change in other ways, such as moving, changing colour or changing to characters overlaid with faces. Methodology/Principal Findings: The present study sought to extend this research direction by parametrically comparing different ways to change items in a P300 BCI. Healthy subjects used a P300 BCI across six different conditions. Three conditions were similar to our prior work, providing the first direct comparison of characters flashing, moving, and changing to faces. Three new conditions also explored facial motion and emotional expression. The six conditions were compared across objective measures such as classification accuracy and bit rate as well as subjective measures such as perceived difficulty. In line with recent studies, our results indicated that the character flash condition resulted in the lowest accuracy and bit rate. All four face conditions (mean accuracy >91\%) yielded significantly better performance than the flash condition (mean accuracy = 75\%). Conclusions/Significance: Objective results reaffirmed that the face paradigm is superior to the canonical flash approach that has dominated P300 BCIs for over 20 years. The subjective reports indicated that the conditions that yielded better performance were not considered especially burdensome. Therefore, although further work is needed to identify which face paradigm is best, it is clear that the canonical flash approach should be replaced with a face paradigm when aiming at increasing bit rate. However, the face paradigm has to be further explored with practical applications particularly with locked-in patients.}, language = {en} } @article{KaethnerKueblerHalder2015, author = {K{\"a}thner, Ivo and K{\"u}bler, Andrea and Halder, Sebastian}, title = {Comparison of eye tracking, electrooculography and an auditory brain-computer interface for binary communication: a case study with a participant in the locked-in state}, series = {Journal of NeuroEngineering and Rehabilitation}, volume = {12}, journal = {Journal of NeuroEngineering and Rehabilitation}, number = {76}, doi = {10.1186/s12984-015-0071-z}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-145305}, year = {2015}, abstract = {Background In this study, we evaluated electrooculography (EOG), an eye tracker and an auditory brain-computer interface (BCI) as access methods to augmentative and alternative communication (AAC). The participant of the study has been in the locked-in state (LIS) for 6 years due to amyotrophic lateral sclerosis. He was able to communicate with slow residual eye movements, but had no means of partner independent communication. We discuss the usability of all tested access methods and the prospects of using BCIs as an assistive technology. Methods Within four days, we tested whether EOG, eye tracking and a BCI would allow the participant in LIS to make simple selections. We optimized the parameters in an iterative procedure for all systems. Results The participant was able to gain control over all three systems. Nonetheless, due to the level of proficiency previously achieved with his low-tech AAC method, he did not consider using any of the tested systems as an additional communication channel. However, he would consider using the BCI once control over his eye muscles would no longer be possible. He rated the ease of use of the BCI as the highest among the tested systems, because no precise eye movements were required; but also as the most tiring, due to the high level of attention needed to operate the BCI. Conclusions In this case study, the partner based communication was possible due to the good care provided and the proficiency achieved by the interlocutors. To ease the transition from a low-tech AAC method to a BCI once control over all muscles is lost, it must be simple to operate. For persons, who rely on AAC and are affected by a progressive neuromuscular disease, we argue that a complementary approach, combining BCIs and standard assistive technology, can prove valuable to achieve partner independent communication and ease the transition to a purely BCI based approach. Finally, we provide further evidence for the importance of a user-centered approach in the design of new assistive devices.}, language = {en} } @article{HalderHammerKleihetal.2013, author = {Halder, Sebastian and Hammer, Eva Maria and Kleih, Sonja Claudia and Bogdan, Martin and Rosenstiel, Wolfgang and Birbaumer, Niels and K{\"u}bler, Andrea}, title = {Prediction of Auditory and Visual P300 Brain-Computer Interface Aptitude}, series = {PLoS ONE}, volume = {8}, journal = {PLoS ONE}, number = {2}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-130327}, pages = {e53513}, year = {2013}, abstract = {Objective Brain-computer interfaces (BCIs) provide a non-muscular communication channel for patients with late-stage motoneuron disease (e.g., amyotrophic lateral sclerosis (ALS)) or otherwise motor impaired people and are also used for motor rehabilitation in chronic stroke. Differences in the ability to use a BCI vary from person to person and from session to session. A reliable predictor of aptitude would allow for the selection of suitable BCI paradigms. For this reason, we investigated whether P300 BCI aptitude could be predicted from a short experiment with a standard auditory oddball. Methods Forty healthy participants performed an electroencephalography (EEG) based visual and auditory P300-BCI spelling task in a single session. In addition, prior to each session an auditory oddball was presented. Features extracted from the auditory oddball were analyzed with respect to predictive power for BCI aptitude. Results Correlation between auditory oddball response and P300 BCI accuracy revealed a strong relationship between accuracy and N2 amplitude and the amplitude of a late ERP component between 400 and 600 ms. Interestingly, the P3 amplitude of the auditory oddball response was not correlated with accuracy. Conclusions Event-related potentials recorded during a standard auditory oddball session moderately predict aptitude in an audiory and highly in a visual P300 BCI. The predictor will allow for faster paradigm selection. Significance Our method will reduce strain on patients because unsuccessful training may be avoided, provided the results can be generalized to the patient population.}, language = {en} } @article{KleihKuebler2013, author = {Kleih, Sonja C. and K{\"u}bler, Andrea}, title = {Empathy, motivation, and P300-BCI performance}, series = {Frontiers in Human Neuroscience}, volume = {7}, journal = {Frontiers in Human Neuroscience}, number = {642}, doi = {10.3389/fnhum.2013.00642}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-130559}, year = {2013}, abstract = {Motivation moderately influences brain-computer interface (BCI) performance in healthy subjects when monetary reward is used to manipulate extrinsic motivation. However, the motivation of severely paralyzed patients, who are potentially in need for BCI, could mainly be internal and thus, an intrinsic motivator may be more powerful. Also healthy subjects who participate in BCI studies could be internally motivated as they may wish to contribute to research and thus extrinsic motivation by monetary reward would be less important than the content of the study. In this respect, motivation could be defined as "motivation-to-help." The aim of this study was to investigate, whether subjects with high motivation for helping and who are highly empathic would perform better with a BCI controlled by event-related potentials (P300-BCI). We included N = 20 healthy young participants na{\"i}ve to BCI and grouped them according to their motivation for participating in a BCI study in a low and highly motivated group. Motivation was further manipulated with interesting or boring presentations about BCI and the possibility to help patients. Motivation for helping did neither influence BCI performance nor the P300 amplitude. Post hoc, subjects were re-grouped according to their ability for perspective taking. We found significantly higher P300 amplitudes on parietal electrodes in participants with a low ability for perspective taking and therefore, lower empathy, as compared to participants with higher empathy. The lack of an effect of motivation on BCI performance contradicts previous findings and thus, requires further investigation. We speculate that subjects with higher empathy who are good perspective takers with regards to patients in potential need of BCI, may be more emotionally involved and therefore, less able to allocate attention on the BCI task at hand.}, language = {en} }